| NPI | 1376039560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 009192) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2019029947) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2023-04-19 |